How fast does ventricular fibrillation fade? Ventricular fibrillation emergency

Today, about 70% of sudden deaths are due to ventricular fibrillation. This disease can affect both young and old people.

This condition leads to the fact that the heart cannot perform its functions, and, accordingly, provide all organs beneficial substances and oxygen. If you see a person who has lost consciousness, immediately call an ambulance, because with this ailment, every minute is important to provide assistance.

When such a condition occurs, immediate resuscitation measures are required. In our article, you will learn what ventricular fibrillation is, how it is right and when to provide assistance, as well as treatment methods and what complications can be.

Ventricular fibrillation is a serious, life-threatening condition that belongs to the group of cardiac arrhythmias. This is a condition incompatible with life, so immediate surgical intervention. The essence of ventricular fibrillation is the abnormal contraction of the muscle tissue of the ventricles, which tremble and the heart thus does not push blood into the body, which leads to circulatory arrest.

The heart consists of four divisions: the right atrium, right ventricle, left atrium and left ventricle. Blood from the whole body flows into the heart, directly into the right atrium.

From there, it enters the right ventricle, which pumps blood into the lungs for oxygenation. From the lungs, blood returns to the heart, to the right atrium, from it to the left ventricle, which pushes it into the body. Whole cardiac cycle depends on contractions of the heart muscle.

The cells of the heart are gifted with the ability to create and send further electrical impulses among themselves, which activate the cells and cause a coordinated contraction of the heart cells so that the muscle tissue of the atria first contracts, the blood is pushed into the ventricles, which then also contract and push the blood into the next section of the circulatory system.

In a healthy heart, an electrical impulse is created by special cells that make up the sinoatrial node.

From there, the impulse propagates in a controlled manner between the cells of the atrium, then through a group of cells - the atrioventricular node - they pass to the cells of the ventricles. Source: "http://ru.medixa.org"

Ventricular fibrillation and flutter are life-threatening cardiac arrhythmias, which are essentially chaotic contractions of ventricular myocardial regions. With fibrillation, the rhythm is irregular, and with ventricular flutter, the appearance of regular electrical activity of the heart remains.

However, with both types of arrhythmia, there is hemodynamic inefficiency, that is, the heart does not perform its main function: pumping. The outcome of such arrhythmias is usually cardiac arrest and clinical death.

Ventricular fibrillation is usually accompanied by contractions of individual groups of muscle fibers of the heart with a frequency of 400 to 600 per minute, less often - from 150 to 300 contractions. With ventricular flutter, individual sections of the heart muscle contract at a frequency of about 250 - 280 per minute.

The development of these rhythm disturbances is associated with the re-entry mechanism, or re-entry. electrical impulse circulates in a circle, causing frequent contractions of the heart muscle without its normal diastolic relaxation.

With ventricular fibrillation, many such re-entry loops appear, which leads to complete disorganization of myocardial contractility. Source: "doctor-cardiologist.ru"

The occurrence of ventricular fibrillation of the heart is explained by the ectopic formation of impulses and (or) the mechanism of re-entry (re-entry) - the formation of zones of functional blockades in the conduction system of the heart and the reverse passage of excitation through these zones. Fibrillation is accompanied by the appearance on the ECG of frequent continuous oscillations, the appearance of which changes as myocardial hypoxia increases.

The precursors of ventricular fibrillation, which play the role of a triggering factor, include early, paired, polygonal ventricular extrasystoles, ventricular tachycardia.

Special prefibrillatory forms of ventricular tachycardia are:

1. alternating;
2. bidirectional (with digitalis intoxication);
3. polymorphic - bidirectional spindle-shaped with congenital and acquired syndromes of prolongation of the Q-T interval;
4. polymorphic ventricular tachycardia with a normal duration of the Q-T interval.

According to the display on the ECG, 5 stages of fibrillation are distinguished:

• Stage I, lasting 20–30 s, is characterized by a regular rhythm and a relatively high frequency of fibrillar oscillations, forming characteristic “spindle” figures (the frequency of oscillations can exceed 400 per 1 min);
• Stage II is determined by the disappearance of the "spindles" and the chaotic character) of the grouping of rhythmic oscillations (the duration of the stage is 20-40 s);
• Stage III is characterized by the absence of frequent rhythmic oscillations and the presence of sinus-like oscillations of doubled frequency (the duration of the stage is 2-3 minutes);
• In stage IV, ordered oscillations disappear
• Stage V is a low-amplitude arrhythmic fibrillar oscillations.

If the patient has no pulse and no breathing, then a "blind" defibrillation should be performed immediately. Everything else - restoration of airway patency, artificial ventilation of the lungs, heart massage is of secondary importance and even at the beginning can play a negative role.

The success of defibrillation decreases with each successive minute. A series of fast discharges of increasing intensity (200, 300, 360 J) is recommended, especially if ventricular fibrillation is detected on the monitor. The task of cardioversion is to eliminate the chaotic activity of the myocardium in order to restore the activity of its own pacemaker.

Blind cardioversion will not harm adult patients with bradycardia and asystole, but will benefit those with ventricular fibrillation or ventricular tachycardia. If there is no ready-made defibrillator, then a precordial beat can be used, but restoration of sinus rhythm is rare (less than 10% of cases).

In children, respiratory arrest is a common cause of death; therefore, “blind” electropulse therapy in them without rhythm analysis is not recommended.

The introduction of adrenaline after the restoration of an independent rhythm can increase vascular tone, improve perfusion of the brain and heart. Source: Meditsina.com

All causes of ventricular fibrillation are divided into two groups. The first group of reasons includes various diseases and pathological conditions the heart muscle itself, the second group includes diseases and conditions not related to the heart, the so-called extracardiac causes.

With a decrease in the electrical stability of the myocardium, ventricular fibrillation occurs. The reasons for the decrease in this stability may be in the increased size of the heart with areas of degeneration and replacement. connective tissue heart muscle, as well as in increasing the activity of the sympathetic nervous system.

Often, ventricular fibrillation occurs against the background of coronary heart disease and its complications in the form of an acute disorder. coronary circulation.

According to statistics, ventricular fibrillation is registered within twelve hours from the onset of acute coronary circulation disorder, being the cause of death in 46% of men and 34% of women. The cause of ventricular fibrillation can be not only acute, but also transferred Q-myocardial infarction, as a result of paroxysmal ventricular tachycardia.

Young people who do not have CAD can also develop ventricular fibrillation.

The etiology of this fibrillation is the presence of hypertrophic cardiomyopathy, which causes a sharp violation of the heart rhythm during intense physical exertion.

Developing ventricular tachycardia acquires a polymorphic form and leads to fibrillation. This causes a collaptoid state of the patient and a sharp violation of blood circulation, which can be observed not only with ventricular fibrillation, but also with other forms of supraventricular tachycardia.

In a tenth of patients, ventricular fibrillation developed against the background of dilated cardiomyopathy. In addition to hypertrophic and dilated cardiomyopathies, Brugada syndrome, right ventricular myopathy, and long QT syndrome can also cause fibrillation. Each of these conditions has its own ECG predictor of fibrillation.

So, with Brugada syndrome and an elongated Q-T segment, ventricular tachycardia of the pirouette type is recorded on the ECG, and with ventricular myopathy, a monomorphic form of ventricular tachycardia. Specific cardiomyopathies that develop against the background of sarcoidosis and inflammation also lead to asynchronous contractions of the ventricles.

In addition to damage to the heart muscle itself, damage to the heart valves can also cause ventricular fibrillation. Basically, this occurs with aortic valve stenosis, regardless of whether it is a congenital or acquired pathology.

While with mitral valve prolapse, even with existing arrhythmia, ventricular fibrillation is extremely rare and is associated more with the associated lesion of the heart muscle itself than with the pathology of the heart valve. Unlike ventricular extrasystoles, in which ventricular fibrillation is rare, ventricular tachycardia often provokes the development of this dangerous condition. Ventricular fibrillation caused by extracardiac causes is quite rare.

This pathology can develop against the background of an overdose of cardiac glycosides, a violation of the electrolyte composition of the blood, and as a result, the development of acidosis.

Also, ventricular fibrillation can be a complication from taking certain drugs (sympathomimetics, barbiturates, antiarrhythmic drugs, narcotic drugs) and narcotic substances, or a complication during instrumental procedures, such as coronary angiography or cardioversion. Source: heart disease.rf

Ventricular fibrillation in 80% of cases is the cause sudden death among all cardiac diseases. This is due to the fact that the absence of urgent effective therapeutic measures within the first minutes after the onset of symptoms inevitably leads to death.

Ventricular fibrillation is a cardiac emergency, manifested by rapid (up to 300 per minute) arrhythmic and uncoordinated contraction of individual muscle groups of the ventricles of the heart, which leads to impaired cardiac output and transient death if timely defibrillation is not performed.

The most common causes of ventricular fibrillation may be:

• acute disorders of the coronary circulation (CHD);
• different kinds cardiomyopathies: hypertrophic, dilatational, arrhythmogenic, idiopathic and others;
• heart defects (valvular disorders), mitral valve prolapse;
• cardiomyopathy in systemic diseases (eg, sarcoidosis, rheumatoid heart disease);
• functional cardiomyopathies associated with impaired conduction, as well as arising from vegetative-vascular dysfunction of the nervous system. Source: "vitaportal.ru"

The mechanism of development of ventricular fibrillation is due to multiple impulses from different parts of the heart, which trigger a series of uncoordinated contractions passing through 4 successive and short stages:

1. Atrial flutter - rhythmic contractions lasting no more than 2 seconds;
2. Large-wave ventricular fibrillation (convulsive stage) - chaotic contractions of different parts of the heart, lasting about 60 seconds;
3. Myocardial flicker (stage of small-wave contractions) - up to 3 minutes;
4. Atony of the heart.

Ventricular fibrillation, the treatment of which depends entirely on the timeliness of the provision emergency assistance leaves little chance for survival.

After 30 seconds from the moment of atrial flutter, the patient loses consciousness, after 50 seconds a typical convulsive state occurs. At the end of 2 minutes, breathing stops and clinical death occurs.

The only option to start the heart and restore the rhythm is effective resuscitation with the use of a defibrillator in the stage of large-wave contractions, which is possible only in a hospital setting. Source: "ritmserdca.ru"

Main symptoms

Early signs:

• chest pain; rapid heartbeat (tachycardia);
• dizziness;
• nausea;
• erratic breathing;
• fainting;
• increased heart rate to a frequency of more than 180 beats per minute at rest;
• sweating;
• feeling of "trembling" of the heart;
• dyspnea;
• vomit.

The condition of ventricular fibrillation, like the ventricular flutter that preceded it, requires immediate medical attention, at the first symptoms it is necessary to consult a doctor and call for medical help. Source: medicalinform.net

You can suspect VF in a person by characteristic signs:

• after 5 sec. a person develops dizziness, weakness occurs;
• after 20 sec. the patient loses consciousness;
• after 40 sec. from the onset of an attack, the patient has characteristic convulsions: skeletal muscles begin to contract once tonically, at the same time defecation and urination involuntarily pass;
• after 45 sec. from the onset of ventricular fibrillation, the pupils dilate, they reach their maximum size after 1.5 minutes.

The breathing of patients with ventricular fibrillation is noisy, frequent, accompanied by wheezing. By the end of the second minute, it becomes less frequent and clinical death occurs. The patient sometimes has time to complain about:

• strong heartbeat;
• dizziness and weakness;
• heartache.

TO outward signs include:

• pallor of the skin and mucous membranes;
• frequent breathing, shortness of breath;
• loss of consciousness;
• lack of pulsation in large arteries.

The doctors have 4 minutes to restore the heart rhythm. If this is not possible, then irreversible changes begin in the body. Source: "oserdce.com"

If the above symptoms occur, the doctor assumes that the patient has ventricular fibrillation. The diagnosis is confirmed by an electrocardiogram. On the ECG, ventricular fibrillation is manifested by chaotic flicker waves, which have different durations and amplitudes. Waves are combined with non-differentiating teeth. The frequency of contractions, as we said at the beginning, is more than three hundred per minute.

Depending on the amplitude of such waves, two more forms of fibrillation can be distinguished:

• large-wave;
• small wave, which is characterized by flicker waves of less than 0.2 mV and a lower probability of hasty defibrillation. Source: "cardio-life.ru"

Diagnostic methods:

• Analysis of the anamnesis of life and complaints (according to relatives and relatives) - how the loss of consciousness occurred, what concomitant diseases the patient had, especially heart disease, whether there were similar cases in relatives.
• Analysis of the history of the disease (when (how long ago) the patient lost consciousness, what preceded this, were there similar cases before).
• Physical examination. The state of consciousness, the presence of breathing, pulse is determined, an examination takes place skin, pupils, blood pressure is measured, auscultation (listening) of the heart - with ventricular fibrillation, heart sounds are not heard.
• General blood analysis. It is carried out to identify comorbidities.
• Complete urinalysis - detects the presence of protein in the urine (an indicator of kidney damage).
• Electrocardiography (ECG) - determined characteristics flutter and ventricular fibrillation.
• Echocardiography (EchoCG) - determination of changes in the heart leading to this condition.
• It is also possible to consult a therapist, resuscitator. Source: lookmedbook.ru

If the above symptoms occur, the doctor assumes that the patient has ventricular fibrillation. The diagnosis is confirmed by an electrocardiogram.

The diagnosis is confirmed by an electrocardiogram. On the ECG, ventricular fibrillation is manifested by chaotic flicker waves, which have different durations and amplitudes.

Waves are combined with non-differentiating teeth. The frequency of contractions, as we said at the beginning, is more than three hundred per minute. Depending on the amplitude of such waves, two more forms of fibrillation can be distinguished:

1. large-wave;
2. small wave, which is characterized by flicker waves of less than 0.2 mV and a lower probability of hasty defibrillation.

First you need to provide emergency care with a closed heart massage. It is very important that emergency care was immediately provided for ventricular fibrillation. If there is no pulse in the large arteries, a closed heart massage should be done. It is also important to do artificial ventilation of the lungs.

The last measure is necessary in order to maintain blood circulation at a level that provides the minimum need for the heart and brain in oxygen. These and subsequent measures should restore the function of these organs. Usually the patient is sent to the intensive care unit, in which the heart rhythm is constantly monitored using an electrocardiogram. So you can determine the form of cardiac arrest and proceed with the necessary treatment. It is also necessary to conduct electrical impulse therapy.

In the first seconds of fibrillation, it is important to conduct electrical impulse therapy, which is often the only method of effective resuscitation.

If electropulse therapy does not bring the expected result, they continue to carry out closed heart massage, as well as artificial ventilation of the lungs. If these measures were not taken earlier, they are being taken. It is believed that if the rhythm has not recovered after three shocks of the defibrillator, it is important to quickly intubate the patient and transfer him to a ventilator.

Thereafter, ventricular fibrillation continues to be treated with sodium bicarbonate solution. The introduction should be carried out every ten minutes until a satisfactory level of blood circulation is restored. It is better to administer drugs through a system that is filled with a five percent glucose solution. For the effectiveness of electropulse therapy, intracardiac administration of a solution of adrenaline hydrochloride is prescribed.

In order to increase the effect of electropulse therapy, intracardiac administration of a solution of adrenaline hydrochloride is prescribed. In combination with a heart massage, it enters the coronary arteries. However, it is worth remembering that intracardiac administration can give complications such as damage to the coronary vessels, pneumothorax, or massive hemorrhage into the myocardium. Drug stimulation also involves the use of mezaton and norepinephrine.

With the ineffectiveness of electropulse therapy, in addition to adrenaline hydrochloride, it is possible to use novocainamide, anaprilin, lidocaine and ornid. Of course, the effect of these drugs will be less than the electropulse therapy itself.

Artificial ventilation and cardiac massage continue, and the defibrillation itself is repeated after two minutes. If after it the heart stops, a solution of calcium chloride and a solution of sodium lactate are introduced.

Defibrillation continues until the heartbeat is restored or until signs of brain death appear. The massage of the heart stops after a distinct pulsation has appeared on the large arteries. The patient should be closely monitored.

It is also very important to carry out preventive measures in order to avoid recurrent ventricular fibrillation of the heart.

However, there are situations when the doctor does not have an apparatus at hand in order to conduct electrical impulse therapy. In this case, you can use a discharge from a conventional electrical network, where the alternating current voltage is 127 V or 220 V. If there are cases when the activity of the heart was restored after a fist hit on the atrial region. Source: "lemariage.com.ua"

Since flutter and ventricular fibrillation are extremely life-threatening, treatment should begin as soon as possible:

• An indirect heart massage (a blow with a hand (fist or palm) to the chest in the area of ​​​​the projection of the heart) and artificial respiration ("mouth to mouth"), if the loss of consciousness occurred outside the medical institution, while qualified medical assistance is expected.
• Defibrillation (the use of a device, the action of which is based on the discharge of electrical impulses, to bring the ventricles out of a state of fibrillation).
• Artificial ventilation of the lungs (supplying oxygen to a person with a special apparatus).
• Adrenaline (a drug that stimulates the activity of the heart, which is administered intravenously).
• Antiarrhythmic drugs (drugs whose action is based on the restoration of a normal heart rhythm). Source: lookmedbook.ru

In ventricular fibrillation, to prevent biological death, emergency measures in the first 4 min.

The absence of a pulse in the carotid or femoral arteries is regarded as an unconditional indication for the immediate start of a closed heart massage and artificial ventilation of the lungs in order to maintain blood circulation at a level that would ensure a minimum oxygen demand of vital organs (brain, heart), and make it possible restoration of their function under the influence of specific treatment.

In the intensive care wards, where there is the possibility of constant monitoring of the heart rhythm with the help of an electrocardiographic study, it is possible to immediately clarify the form of cardiac arrest and begin specific treatment. With ventricular fibrillation, the most effective is the rapid conduct of electrical impulse therapy, especially in the first seconds of its occurrence.

Often, in primary ventricular fibrillation, timely electrical impulse therapy remains practically the only measure used in the resuscitation process.

In case of primary ventricular fibrillation, electropulse therapy performed within 1 minute restores the work of the heart in 60-80%, and at the 3-4th minute (if heart massage and artificial ventilation of the lungs were not performed) - only in isolated cases. If electropulse therapy is ineffective, to normalize metabolic processes in the myocardium, they continue (or start) closed heart massage and artificial ventilation of the lungs (preferably with excessive oxygenation).

The next important event is the introduction of alkalizing solutions, since clinical death develops metabolic acidosis. 200 ml of 5% or 50 ml of 7.5% sodium bicarbonate solution is injected into the vein every 10 minutes until satisfactory blood circulation is restored or it becomes possible to control blood pH. More precisely, a single dose of sodium bicarbonate can be determined by the formula (A. Gilston, 1972).

Intravenous administration medications it is better to start immediately through a system filled with 5% glucose solution.

To increase the effectiveness of electropulse therapy, intracardiac administration of 1 ml of a 0.1% solution of adrenaline is used, which, under the influence of heart massage, enters the coronary arteries from the ventricular cavity. It must be remembered that intracardiac administration of the drug can lead to pneumothorax, damage to the coronary vessels, massive hemorrhages in the myocardium. In the future, the introduction of adrenaline into a vein or intracardiac (1 mg) is repeated every 2-5 minutes. For drug stimulation, norepinephrine and mezaton are also used.

If electropulse therapy is ineffective, intracardiac, in addition to adrenaline, novocaine (0.001 g / kg), novocainamide (0.001-0.003 g / kg), xicaine or lidocaine (0.1 g), anaprilin (obzidan) from 0.001 to 0.005 g, ornid (0.5 g). The introduction of these drugs in ventricular fibrillation is less effective than electrical impulse therapy. Continue artificial ventilation of the lungs and heart massage. After 2 minutes, another defibrillation is performed. If, after defibrillation, heart contractions stop, then 5 ml of a 10% solution of calcium chloride, 15-30 ml of a 10% solution of sodium lactate are used.

Defibrillation continues either until the restoration of heart contractions, or until signs of brain death appear. After the appearance of a distinct independent pulsation on the large arteries, the closed heart massage stops.

In the next few hours, intensive monitoring of the patient and measures to prevent recurrent ventricular fibrillation are necessary. If the doctor does not have equipment for conducting electropulse therapy, it can be performed by a discharge from a conventional electrical network with an alternating current of 127 and 220 V. Cases of restoration of cardiac activity after a fist hit to the atrial region are described.

Sometimes ventricular fibrillation occurs so often that defibrillation has to be performed 10-20 times or more per day. It is possible to eliminate the recurrence of fibrillation in such cases by selecting effective antiarrhythmic drugs and connecting an artificial pacemaker (see also "Antiarrhythmic drugs"). Source: "cardiology-manual.com.ua"

Ventricular fibrillation - emergency care

The condition that develops with fibrillation requires emergency intervention and resuscitation activities.

The task of resuscitation is to provide artificial ventilation of the lungs and restore blood circulation. In the absence of a defibrillator at the pre-medical stage, in order to restore the heart rhythm, a so-called precordial stroke is performed.

This technique is a sharp punch to the heart projection area (lower third of the sternum). Due to a sharp push, a reflex restoration of the heart rhythm and the elimination of the threat of further fibrillation are possible.

After the precordial beat, an indirect heart massage is performed along with artificial respiration before the arrival of a specialized resuscitation team. With the ineffectiveness of previous resuscitation measures, the following is carried out:

• defibrillation with a discharge of 200 J. If necessary, repeat;
• defibrillation with an increasing charge indicator.

The increase in charge during repeated defibrillations should not be abrupt, as a high charge can cause a post-conversion complication. In the primary form of fibrillation, such therapy is most effective. The earlier defibrillation is performed, the greater the chance of restoring the heart rhythm and saving the patient's life.

According to statistics, during electropulse therapy, within the first minute from the onset of fibrillation, the heart rhythm is restored in 75% of cases. If defibrillation was performed in the fourth minute, a positive outcome is observed in isolated cases.

If the therapy is ineffective, adrenaline is administered intracardiac, followed by intravenous administration. After the heart rhythm is restored, conservative therapy with the introduction of vasoactive drugs and electrolyte solutions. Treatment of ventricular fibrillation, in addition to resuscitation and electrical impulse therapy, consists in the intravenous administration of a soda solution to eliminate acidosis, the injection of Lidocaine up to 100 mg to stabilize the function of the conduction system.

All drug therapy is carried out against the background of mechanical artificial ventilation of the lungs and closed heart massage, which is carried out until the restoration of normal myocardial contraction and the determination of pulsation in large arteries.

In the future, to prevent a recurrent attack, the patient is monitored around the clock and intensively treated for the underlying disease that caused ventricular fibrillation.

Ventricular fibrillation of the heart is the most severe form of violation of its rhythm. It leads to cardiac arrest and the development of clinical death within a few minutes. This is a borderline condition requiring immediate resuscitation. Therefore, the life of a person after an attack depends on the timeliness and literacy of the actions of people who are nearby.

According to statistics, men over the age of 45 with various forms of heart pathologies are susceptible to the disease. It is the diseases of this organ that are the main cause of the development of ventricular fibrillation.

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Basic concept

Ventricular fibrillation, or flickering, is emergency characterized by uncoordinated contractions of the ventricles of the heart. Often their frequency exceeds 300 beats per minute. During this period, the function of this organ for pumping blood is disturbed, and after a while it stops altogether.

The attack is preceded by a condition called "ventricular flutter" - unstable arrhythmic heartbeats with a frequency of 220 to 300 per minute, which quickly turn into fibrillation.

ventricular fibrillation

The basis of the disease is a violation of the electrical activity of the myocardium and the cessation of full-fledged heart contractions, leading to circulatory arrest.

Men are three times more likely than women to suffer from ventricular fibrillation. It accounts for about 80% of all cases of cardiac arrest.



The mechanism of development of pathology

The essence of the mechanism of development of ventricular fibrillation lies in the uneven electrical activity of the heart muscle - myocardium. This leads to the contraction of individual muscle fibers at an unequal rate, as a result, different parts of the myocardium are in different phases of contraction. The frequency of contractions of some fibers reaches 500 per minute. This whole process is accompanied by a chaotic work of the heart muscle, which is not able to provide normal blood circulation. After some time, the human heart stops and clinical death occurs. If you do not start cardiopulmonary resuscitation, then after 5-6 minutes there will be irreversible changes in the body and brain death.

Flutter and ventricular fibrillation are the most dangerous species arrhythmias. Their difference lies in the fact that the former preserves right rhythm contractions of myocardial cells - cardiomyocytes, and their frequency does not exceed 300 per minute. Fibrillation is characterized by erratic contraction of cardiomyocytes and irregular rhythm.



Flutter and ventricular fibrillation

Ventricular flutter is the first stage of fibrillation.



Causes and predisposing factors

There are many factors that affect myocardial conduction and its ability to contract. Of these, 90% are due to cardiovascular diseases.

The main causes of ventricular fibrillation:

Factor	Pathologies
Cardiovascular diseases	ventricular paroxysmal tachycardia - a sudden attack of rapid heartbeat that occurs under the influence of impulses that replace normal sinus rhythm hearts; ventricular extrasystole - a violation of the heart rhythm, in which an extraordinary contraction of the ventricles occurs; myocardial infarction - mass death of cells of the muscle tissue of the heart due to insufficient blood supply; acute coronary insufficiency - a violation of blood circulation in the heart; cardiomegaly, or "bull's heart", - an abnormal increase in the size or mass of an organ; Brugada syndrome - a genetically determined disorder of the heart; atrioventricular block - a violation of electrical conduction between the ventricles and atria, leading to arrhythmias; malformations of the heart and its valves; cardiomyopathy - a pathology of the myocardium of an unclear nature, characterized by an increase in the size of the heart and its chambers, rhythm disturbance, heart failure; cardiosclerosis - gradual replacement of the myocardium with connective tissue; myocarditis - inflammation of the heart muscle
Electrolyte imbalance	insufficient intake of potassium in the body, leading to electrical instability of the myocardium; excess accumulation of calcium within cells
Taking medication	Intoxication caused by the following groups of drugs: sympathomimetics - Orciprenaline, Epinephrine, Salbutamol; cardiac glycosides - Digitoxin, Digoxin; anti-arrhythmia drugs - Amiodarone, Sotalol; narcotic analgesics - Levomepromazine, Chlorpromazine; catecholamines - Dopamine, Norepinephrine, Adrenaline; barbiturates - Seconal, Phenobarbital; medical anesthesia - Chloroform, Cyclopropane
Injuries	electric shock; blunt cardiac injury; penetrating chest wounds
Medical manipulations	coronary angiography - the introduction of a contrast agent into the circulatory system of the heart, followed by radiography; cardioversion - treatment of cardiac arrhythmias through electrical impulses
Burns, overheating	temperature increase; fever with sudden changes in temperature
Insufficient supply of oxygen	skull trauma; suffocation
Other reasons	acidosis - a decrease in the pH of the body, that is, a shift in the acid-base balance towards an increase in acidity; dehydration associated with blood loss of a different nature; hypovolemic shock - a critical condition that occurs due to a sharp loss of circulating blood in the body



Myocardial infarction as a cause of ventricular fibrillation.

Risk factors include:

• male gender;
• age over 45 years.



Clinical picture

Ventricular fibrillation occurs suddenly. Their function is sharply disturbed, which leads to circulatory arrest. This process entails the development of acute ischemia (oxygen starvation) of the internal organs and the brain. The patient stops moving and loses consciousness.

The main symptoms of pathology:

• failure of the heart rhythm;
• sharp pain in the head;
• dizziness;
• sudden loss of consciousness;
• cardiac arrest;
• intermittent breathing or its absence;
• pallor of the skin;
• acrocyanosis (cyanosis of the skin), especially in the region of the nasolabial triangle, nose and tips of the ears;
• inability to feel the pulse on the carotid and femoral arteries;
• dilated pupils and lack of their reaction to light;
• hypotension (relaxation) of muscles or convulsions;
• sometimes - involuntary defecation and urination.

All signs occur almost simultaneously, with a fatal outcome occurring within an hour from the onset of the first symptom in 98% of cases.

After a complete cardiac arrest, a person can be brought back to life within seven minutes. During this time, changes in the body are considered reversible. Then irreversible processes of cellular decay and biological death of the brain begin.

Ventricular fibrillation stages and ECG readings

An attack of fibrillation is manifested by symptoms of clinical death. This condition can be recognized using electrocardiography (ECG) - the most informative diagnostic method.



ECG readings

Benefits of an ECG:

• quick results;
• the possibility of carrying out the procedure outside the clinic or hospital.

Characteristic features of ventricular fibrillation on the ECG:

1. 1. Lack of registration of excitation of the ventricles of the heart on the ECG, that is, the ventricular complex or the QRS complex.
2. 2. Determination of irregular, different in duration and amplitude fibrillation waves, the intensity of which reaches 400 per minute.
3. 3. Absence of an isoline.

Based on the size of the waves, there are two types of ventricular fibrillation:

1. 1. Large-wave - excess force of contractions above one cell (0.5 cm) when recording electrocardiography. The definition of this type of flicker is noted in the first minutes of an attack and means the beginning of an arrhythmia.
2. 2. Small-wave - manifests itself with the depletion of cardiomyocytes, an increase in signs of acidosis and disorders of metabolic processes in the body, which is characterized by a high risk of death.

The sequence of stages of arrhythmia, determined on the ECG:

1. 1. Tachysystolic - flutter lasting about two seconds.
2. 2. Convulsive - loss of regularity of contractions of the heart muscle and an increase in their frequency. The duration of the stage is not longer than one minute.
3. 3. Atrial - irregular frequent contractions of varying intensity, without pronounced teeth and intervals. The duration of the stage is 2–5 minutes.
4. 4. Atonic - change of large waves of fibrillation to small ones as a result of myocardial exhaustion. Stage time - up to 10 minutes.
5. 5. Final - complete cessation of cardiac activity.



Ventricular fibrillation on EKG

Depending on the duration of the attack, ventricular fibrillation is divided into two forms:

1. 1. Paroxysmal - short-term episodes of the development of pathology.
2. 2. Constant - rhythm disturbance, characterized by a sudden death clinic.

Urgent care

ECG is necessary in the diagnosis of ventricular fibrillation, but resuscitation should begin immediately, without waiting for its results. Otherwise, the person may die.

The main principle of emergency care is to start it as soon as possible, because the death of the patient can occur within a few minutes. If it is impossible to carry out emergency defibrillation, the victim is shown an indirect heart massage and artificial ventilation of the lungs. Proper heart massage for 4 minutes ensures blood oxygen saturation up to 90% even in the absence of artificial respiration. Thus maintaining vital organs until arrival specialized care increases a person's chances of life.

• assessment of the patient's condition;
• determination of respiration and pulse;
• providing the patient with a horizontal position lying on his back with his head thrown back with the removal of the lower jaw forward;
• examination of the patient's oral cavity for the presence of foreign bodies;
• in the absence of breathing and pulse - immediate resuscitation. If the resuscitator is alone, then the ratio of air injections and chest compressions is 2:30. If two people are resuscitated, then this is 1:5.



Non-specialized resuscitation

Specialized care includes the use of a defibrillator and drug therapy. Before this, an ECG is done (in parallel with cardiopulmonary resuscitation) to confirm ventricular fibrillation, since in other cases the defibrillator may not have the desired effect.

Specialized emergency care is carried out in several stages, of which each subsequent begins with the ineffectiveness of the previous one:

Stage	Order of conduct
First	1. Determination of the presence of consciousness in the patient. 2. Ensuring the opening of the airways. 3. After monitoring the pulse and respiration - conduct cardiopulmonary resuscitation (CPR). The frequency of chest compressions is 100 per minute. At the same time, artificial lung ventilation (ALV) "mouth to mouth" is performed. If an Ambu bag is used, then the ratio of mechanical ventilation and chest compressions (NMS) is 2:30. 4. In parallel with CPR - taking ECG readings
Second	1. Conducting an ECG analysis to determine the need for defibrillation. 2. When clarifying ventricular fibrillation by means of ECG - defibrillation 360 J + 2 more times in the absence of a result. 3. At the same time - preparation of instruments for tracheal intubation (aspirator, laryngoscope, air duct, etc.) and solution for endotracheal administration (Adrenaline 3 mg and sodium chloride 0.9% 7 ml)
Third	1. Perform CPR for one minute. 2. Tracheal intubation for half a minute. 3. In parallel - NMS. 4. Introduction of a catheter into the main vein. 5. Intravenous jet infusion of 1 ml of Adrenaline or endotracheal administration of its solution. 6. IVL + NMS
Fourth	1. Defibrillation 360 J. 2. The introduction of Cordarone (amiodarone) 150–300 mg or lidocaine 1 mg per kilogram of body weight intravenously. 3. NMS + IVL. 1. Defibrillation 360 J. 5. In case of inefficiency - re-introduction of cordarone and NMS + mechanical ventilation after 3-5 minutes. 6. In case of inefficiency - intravenously 10 ml of Novocainamide 10% and repeated cardiopulmonary resuscitation. 1. Defibrillation 360 J. 8. In case of ineffectiveness - intravenous administration of Ornida at the rate of: 5 mg per kilogram of weight every 5-10 minutes until the dose is 20 mg per kilogram of weight. After each injection of Ornid - defibrillation 360 J

Places of correct installation of electrodes.

If the measures taken did not give an effect, then the issue of the subsequent implementation of resuscitation actions is decided.

According to statistics, with the help of a defibrillator, the work of the heart is restored in 95% of cases if there is no serious organic damage to the heart muscle. Otherwise positive effect does not exceed 30%.

Complications

After the return of a person to life, a prerequisite is his transfer to the intensive care unit, and then to the intensive care unit. This is due to the instability of blood circulation and the consequences of oxygen starvation of the brain and other organs.

Consequences of the postponed arrhythmia:

1. 1. Post-anoxic encephalopathy - damage to brain neurons as a result of prolonged oxygen starvation. This condition is manifested by neurological and psycho-emotional disorders of a different nature. A third of patients who have experienced clinical death develop neurological complications that are incompatible with life. The second third have violations motor activity and sensitivity.
2. 2. A persistent decrease in blood pressure - hypotension against the background of myocardial infarction.
3. 3. Asystole - complete cardiac arrest. It is a complication of the attack of ventricular fibrillation.
4. 4. Fractures of the ribs and other injuries of the chest as a consequence of intensive chest compressions.
5. 5. Hemothorax - accumulation of blood in the pleural cavity.
6. 6. Pneumothorax - the appearance of gases or air in the pleural cavity.
7. 7. Myocardial dysfunction - disruption of the heart muscle.
8. 8. Aspiration pneumonia - inflammation of the lungs as a result of ingestion of vomit or other substances from the mouth and nose.
9. 9. Other types of arrhythmias (heart rhythm disturbances).
10. 10. Thromboembolism - getting into the pulmonary artery of blood clots and its blockage.



Thromboembolism pulmonary artery as a complication of resuscitation

When the work of the heart is restored after 10–12 minutes of clinical death, there is a high probability of developing coma, physical and mental disability. This is due to prolonged hypoxia of the brain and the occurrence of irreversible processes in it. The absence of brain disorders is observed in only 5% of people who have undergone cardiac arrest.

Prevention and prognosis

Prevention of ventricular fibrillation can significantly prolong a person's life. This is true both with the likelihood of developing pathology, and after an attack. In the case of the latter, the risk of relapse increases several times.

Preventive measures against ventricular fibrillation:

1. 1. Timely and quality treatment cardiovascular pathology.
2. 2. Regular use of drugs with antiarrhythmic effect.
3. 3. Installation of a cardioverter-defibrillator or pacemaker.



Installed pacemaker

The death rate from ventricular fibrillation in people over 45 years of age is more than 70% annually. The prognosis is not always favorable and depends on the effectiveness and professionalism of resuscitation measures, as well as on the time the patient is in a state of clinical death.

Fatal outcome with ventricular fibrillation occurs in 80% of cases. The cause of 90% of attacks are diseases of the cardiovascular system (heart defects, cardiomyopathy, cardiosclerosis, myocardial infarction). Ischemic heart disease causes sudden death in women in 34% of cases, in men - in 46%.

There is no cure for ventricular fibrillation. Emergency resuscitation measures can prolong life in only 20% of patients. A positive result is 90% when providing assistance in the first minute of cardiac arrest. Resuscitation at the fourth minute reduces this figure three times and does not exceed 30%.

Fibrillation, or ventricular fibrillation, is a formidable disorder with a high risk lethal outcome. A favorable prognosis depends on timely and high-quality first aid. Of particular importance is prevention, aimed at preventing the development of pathology.

Ventricular fibrillation is characterized as uncoordinated, arrhythmic, scattered contractions that occur in separate groups of muscle fibers of the heart ventricles. The frequency of such contractions reaches more than 300 per minute. All this is accompanied by the fact that the heart cannot perform pumping functions, the blood supply to the whole organism stops. This situation calls for immediate resuscitation measures. If you do not start them within ten minutes, the patient will die.

As you can see, ventricular fibrillation requires special attention, as it often causes sudden cardiac death. Sudden cardiac death occurs due to sudden cardiac arrest. If you do not immediately restore his activity, a person will die within just a few minutes. Since cardiac arrest occurs due to dysfunction of the electrical system that controls the rhythm of the heart, recovery is carried out by electric shock. As we have already said, fibrillation mainly leads to this. First, let's talk about why it occurs.

Causes

Most often, ventricular fibrillation is a complication of coronary heart disease or myocardial infarction. Causes can serve as cardiomyopathy of various etiologies, among which the main role should be assigned to hypertrophic cardiomyopathy. In this case, sudden cardiac death occurs during intense physical exertion in young people. Fibrillation can also occur due to heart defects and due to a violation of the properties of the myocardium, even when there are no obvious heart diseases.

In addition, some risk factors can be identified that also affect fibrillation.

• Hypoxia.
• General cooling of the body.
• Violations of the acid-base state.
• Violations of the water-electrolyte state.
• Endogenous and exogenous factors affecting the myocardium.
• Mechanical stimulation of the heart and so on.

Although ventricular fibrillation is mainly due to coronary artery disease and infarction, it is worth paying attention to electrolyte imbalance, especially calcium and potassium metabolism disorders.

Intracellular hypokalemia, a companion of hypoxic conditions, increases the excitability of the myocardium, which leads to the appearance of paroxysms of disruption of the sinus rhythm. Hypokalemia also leads to a decrease in myocardial tone. Cardiac activity can also be upset due to the fact that the ratio and concentration of Ca ++ and K + cations change. These disorders lead to a change in the cell-extracellular gradient, which can cause disturbances in the processes of contraction and excitation of the myocardium. Fibrillation can be caused by a rapid increase in the concentration of potassium in the plasma against the background of the fact that its level in the cells is reduced. The myocardium cannot fully contract with intracellular hypocalcemia.

Symptoms

Definitely the importance in the consideration of this topic should be given to the symptoms that characterize ventricular fibrillation. Their timely recognition will help to provide emergency assistance in time and save a person's life.

There are two forms of fibrillation.

1. Primary. It is not associated with AHF (acute heart failure) and does not have signs of ALHF (acute left ventricular failure). It develops due to electrical instability of the myocardium in the area of ​​necrosis and occurs suddenly in the first two days of myocardial infarction. Approximately sixty percent of her episodes develop in the first few hours. This form leads to death not as often as the other, secondary form and can be stopped in eighty percent of cases.
2. secondary form. It develops against the background of significant heart failure, but in more late dates myocardial infarction. This period may be the period of activation of the patient, that is, the second, third or fourth week. The basis of the origin of this form is the defeat of the pumping function of the myocardium. Ventricular fibrillation can develop against the background of atrial fibrillation or even without precursors. Unfortunately, with this form, resuscitation brings a very small effect and mortality occurs in seventy percent of cases.

Since the pumping function of the heart ceases during fibrillation, a sudden cessation of blood circulation occurs and, as a result, clinical death. In this case, the person loses consciousness, which can also be accompanied by the following manifestations:

• convulsions;
• involuntary urination;
• involuntary defecation;
• dilated pupils that do not respond to light;
• diffuse cyanosis;
• lack of pulsation in large arteries;
• lack of breathing;
• Without effective assistance irreversible changes begin to develop in the central nervous system and other parts of the body.

Diagnostics

If the above symptoms occur, the doctor assumes that the patient has ventricular fibrillation. The diagnosis is confirmed by an electrocardiogram.

On the ECG, ventricular fibrillation is manifested by chaotic flicker waves, which have different durations and amplitudes. Waves are combined with non-differentiating teeth. The frequency of contractions, as we said at the beginning, is more than three hundred per minute. Depending on the amplitude of such waves, two more forms of fibrillation can be distinguished:

1. large-wave;
2. small wave, which is characterized by flicker waves of less than 0.2 mV and a lower probability of hasty defibrillation.

Treatment

It is very important that emergency care was immediately provided for ventricular fibrillation. If there is no pulse in the large arteries, a closed heart massage should be done. It is also important to do artificial ventilation of the lungs. The last measure is necessary in order to maintain blood circulation at a level that provides the minimum need for the heart and brain in oxygen. These and subsequent measures should restore the function of these organs.

Usually the patient is sent to the intensive care unit, in which the heart rhythm is constantly monitored using an electrocardiogram. So you can determine the form of cardiac arrest and proceed with the necessary treatment.

In the first seconds of fibrillation, it is important to conduct electrical impulse therapy, which is often the only method of effective resuscitation. If electropulse therapy does not bring the expected result, they continue to carry out closed heart massage, as well as artificial ventilation of the lungs. If these measures were not taken earlier, they are being taken. It is believed that if the rhythm has not recovered after three shocks of the defibrillator, it is important to quickly intubate the patient and transfer him to a ventilator.

Thereafter, ventricular fibrillation continues to be treated with sodium bicarbonate solution. The introduction should be carried out every ten minutes until a satisfactory level of blood circulation is restored. It is better to administer drugs through a system that is filled with a five percent glucose solution.

In order to increase the effect of electropulse therapy, intracardiac administration of a solution of adrenaline hydrochloride is prescribed. In combination with a heart massage, it enters the coronary arteries. However, it is worth remembering that intracardiac administration can give complications such as damage to the coronary vessels, pneumothorax, or massive hemorrhage into the myocardium. Drug stimulation also involves the use of mezaton and norepinephrine.

With the ineffectiveness of electropulse therapy, in addition to adrenaline hydrochloride, it is possible to use novocainamide, anaprilin, lidocaine and ornid. Of course, the effect of these drugs will be less than the electropulse therapy itself. Artificial ventilation and cardiac massage continue, and the defibrillation itself is repeated after two minutes. If after it the heart stops, a solution of calcium chloride and a solution of sodium lactate are introduced. Defibrillation continues until the heartbeat is restored or until signs of brain death appear. The massage of the heart stops after a distinct pulsation has appeared on the large arteries. The patient should be closely monitored. It is also very important to carry out preventive measures in order to avoid recurrent ventricular fibrillation of the heart.

However, there are situations when the doctor does not have a device at hand in order to conduct electrical impulse therapy. In this case, you can use a discharge from a conventional electrical network, where the alternating voltage current is 127 V or 220 V. There are cases when the activity of the heart was restored after a fist hit on the atrial region.

Complications

Unfortunately, it is almost impossible to avoid serious complications after fibrillation has occurred. This can only be the case when defibrillation was carried out in the first seconds of an attack, but even then the likelihood that complications will not arise is small.

Cardiac arrest itself is accompanied by total myocardial ischemia. Once circulation is restored, myocardial dysfunction often occurs. After resuscitation, arrhythmias and complications associated with the lungs, such as aspiration pneumonia, may occur. Neurological complications may also develop, which occur due to impaired blood supply to the brain of the head.

Prevention

It should be remembered that ventricular fibrillation occurs due to cardiovascular disease. That is why the essence of prevention is effective treatment underlying disease. A person must follow the doctor's instructions and lead healthy lifestyle life.

A healthy lifestyle involves avoiding alcohol and tobacco. It is very important to eat right and lead an active lifestyle. However, it is important not to overdo it with loads. Secondary prevention includes active treatment of heart failure and ischemia. For this, antiarrhythmic drugs are used.

Speaking about flutter and ventricular fibrillation, it should be remembered that we are talking not just about a person’s health, but about his life. Therefore, an attentive attitude towards yourself and your loved ones can prolong a life that should be happy and filled with meaning!